Dems can win on Medicare

As deficit talks come down to the wire, both parties have a lot to gain — and just as much to lose — when it comes to Medicare. Whoever wins the debate could very likely win the senior vote and the November 2012 elections along with it. The stakes could not be higher.

The winning side will most likely be the one that effectively presents a coherent and politically sensible plan for transforming, not just cutting, Medicare.

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President Barack Obama’s willingness to take on the issue of entitlements generally and address Medicare reform as part of a debt-limit deal should be commended — and should help Democrats. But only if it’s focused on three core principles: keeping seniors healthy and in their homes, smartly cracking down on fraud and abuse and avoiding policies that increase spending down the road.

Some background: Medicare is America’s second-biggest spending program after Social Security. It cost $450 billion in 2010.

But almost no politician wants to simply reduce it. Only 21 percent of Americans favor any cuts at all, according to an April ABC News/Washington Post poll. A Republican plan to end Medicare for those under 55 remains deeply unpopular. So the program needs new thinking.

This should start with the most straightforward approach: keeping Medicare beneficiaries healthy and in their homes. Home health care is overwhelmingly popular — 73 percent of voters oppose cutting it in any way. It costs a fraction of nursing facility and hospital care, so it makes economic sense, too. Yet there is now talk of imposing fees — in the form of “co-payments” — on seniors who receive home care. It would be a politically lethal move if included in any final deal.

For Republicans, imposing co-payments or other fees on seniors comes with significant risk. Some Republicans say seniors should bear this burden — to have “skin in the game.” But this ignores that seniors are the one voting bloc that has put unparalleled skin in the game.

They paid their taxes, built our nation and defended its freedom. Taking or taxing their hard-earned benefits is, not surprisingly, deeply unpopular. Just look at how health reform and Rep. Paul Ryan’s Medicare plan fared with the electorate. Both were viewed as narrowing benefits and increasing costs — and both were strongly panned.

Republicans, therefore, must find a way to achieve cost savings without imposing co-payments or other fees on seniors.

For Democrats, this debate presents a compelling opportunity to be responsible fiscal players. For example, they can steer clear of the political land mines and still achieve substantial cost savings by addressing pervasive Medicare fraud.